Third Session - Fortieth Legislature

of the

Legislative Assembly of Manitoba

Standing Committee on Public Accounts

Chairperson Mr. Reg Helwer Constituency of Brandon West

Vol. LXVI No. 5 - 2 p.m., Wednesday, July 9, 2014

ISSN 0713-9462 MANITOBA LEGISLATIVE ASSEMBLY Fortieth Legislature

Member Constituency Political Affiliation

ALLAN, Nancy St. Vital NDP ALLUM, James, Hon. Fort Garry-Riverview NDP ALTEMEYER, Rob Wolseley NDP ASHTON, Steve, Hon. Thompson NDP BJORNSON, Peter, Hon. Gimli NDP BLADY, Sharon, Hon. Kirkfield Park NDP BRAUN, Erna, Hon. Rossmere NDP BRIESE, Stuart Agassiz PC CALDWELL, Drew Brandon East NDP CHIEF, Kevin, Hon. Point Douglas NDP CHOMIAK, Dave, Hon. Kildonan NDP CROTHERS, Deanne St. James NDP CULLEN, Cliff Spruce Woods PC DEWAR, Gregory Selkirk NDP DRIEDGER, Myrna Charleswood PC EICHLER, Ralph Lakeside PC EWASKO, Wayne Lac du Bonnet PC FRIESEN, Cameron Morden-Winkler PC GAUDREAU, Dave St. Norbert NDP GERRARD, Jon, Hon. River Heights Liberal GOERTZEN, Kelvin Steinbach PC GRAYDON, Cliff Emerson PC HELWER, Reg Brandon West PC HOWARD, Jennifer, Hon. Fort Rouge NDP IRVIN-ROSS, Kerri, Hon. Fort Richmond NDP JHA, Bidhu Radisson NDP KOSTYSHYN, Ron, Hon. Swan River NDP LEMIEUX, Ron, Hon. Dawson Trail NDP MACKINTOSH, Gord, Hon. St. Johns NDP MALOWAY, Jim Elmwood NDP MARCELINO, Flor, Hon. Logan NDP MARCELINO, Ted Tyndall Park NDP MARTIN, Shannon Morris PC MELNICK, Christine Riel Ind. MITCHELSON, Bonnie River East PC NEVAKSHONOFF, Tom Interlake NDP OSWALD, Theresa, Hon. Seine River NDP PALLISTER, Brian Fort Whyte PC PEDERSEN, Blaine Midland PC PETTERSEN, Clarence Flin Flon NDP PIWNIUK, Doyle Arthur-Virden PC REID, Daryl, Hon. Transcona NDP ROBINSON, Eric, Hon. Kewatinook NDP RONDEAU, Jim Assiniboia NDP ROWAT, Leanne Riding Mountain PC SARAN, Mohinder The Maples NDP SCHULER, Ron St. Paul PC SELBY, Erin, Hon. Southdale NDP SELINGER, Greg, Hon. St. Boniface NDP SMOOK, Dennis La Verendrye PC STEFANSON, Heather Tuxedo PC STRUTHERS, Stan, Hon. Dauphin NDP SWAN, Andrew, Hon. Minto NDP WIEBE, Matt Concordia NDP WIGHT, Melanie Burrows NDP WISHART, Ian Portage la Prairie PC Vacant The Pas

89

LEGISLATIVE ASSEMBLY OF MANITOBA THE STANDING COMMITTEE ON PUBLIC ACCOUNTS Wednesday, July 9, 2014

TIME – 2 p.m. Honourable Ms. Howard, Mrs. Driedger in for Mr. Pedersen and Mr. Ewasko in for Mr. Schuler. LOCATION – Winnipeg, Manitoba * * * CHAIRPERSON – Mr. Reg Helwer (Brandon West) Mr. Chairperson: Are there any suggestions from the committee as to how long we should sit this VICE-CHAIRPERSON – Mr. Matt Wiebe afternoon? (Concordia) Mrs. Myrna Driedger (Charleswood): I would ATTENDANCE – 10 QUORUM – 6 recommend that we sit 'til 4 o'clock and then Members of the Committee present: re-evaluate where we're at at that time. Hon. Mr. Struthers Mr. Chairperson: Is it the will of the committee? [Agreed] Mr. Dewar, Mrs. Driedger, Messrs. Ewasko, Friesen, Helwer, Jha, Marcelino, Wiebe, We will sit 'til 4 o'clock and evaluate at this–at Ms. Wight that time. Substitutions: At this time I'd like to invite the minister and deputy minister to the table. Hon. Mr. Struthers for Hon. Ms. Howard Mrs. Driedger for Mr. Pedersen And does the Auditor General wish to make an Mr. Ewasko for Mr. Schuler opening statement? APPEARING: Mr. Norm Ricard (Acting Auditor General): I do. Mr. Norm Ricard, Acting Auditor General Mr. Chairperson: Mr. Ricard. WITNESSES: Mr. Ricard: Thank you, Mr. Chairperson. I'm here today in my new role as acting Auditor General. It Hon. Erin Selby, Minister of Health will, indeed, be my pleasure to function in this Ms. Karen Herd, Deputy Minister of Health capacity for as long as the Legislative Assembly MATTERS UNDER CONSIDERATION: calls–may call upon me to do so. I would first like to introduce Brian Wirth, who Auditor General's Report–Annual Report to the is sitting behind me. Brian is the assistant auditor Legislature, dated March 2014 general responsible for directly overseeing our audit Chapter 4–Helicopter Ambulance Program of the helicopter ambulance program. * * * In 2009, a study was conducted by the Department of Health in consultation with Mr. Chairperson: Good afternoon. Will the industry experts to determine the feasibility of the Standing Committee on Public Accounts please helicopter emergency medical response program in come to order. Manitoba. The study supported further planning and This meeting has been called to consider consideration for such a program. Chapter 4–Helicopter Ambulance Program of the On February 22nd, 2012, the Province, Auditor General's Report–Annual Report to the represented by the Department of Health, signed a Legislature, dated March 2014. 10-year service purchase agreement for helicopter Committee Substitutions ambulance services with the Shock Trauma Air Rescue Society, STARS for short. Mr. Chairperson: Pursuant to our rule 85(2), I would like to inform that for today's meeting, Of note, however, is that Manitoba's relationship Honourable Mr. Struthers will be substituting in for with STARS began during the 2009 flood 90 LEGISLATIVE ASSEMBLY OF MANITOBA July 9, 2014 when STARS was issued an untendered five-week Health noted that the budgeted costs appeared high, contract to provide helicopter–to provide emergency but a more detailed analysis of the budgeted numbers helicopter medevac services. An untendered contract provided by STARS was not done. was also issued to STARS during the 2011 flood. When Health became aware of patient-care Our audit of the helicopter ambulance program concerns, it responded by implementing medical had two initial objectives. The first was to assess reviews and operational changes, including the hiring whether the purchase of helicopter ambulance of an experienced independent medical doctor to services from STARS was in compliance with identify any underlying systemic issues. We found, provincial procurement principles, policies and however, that Health lacked a quality assurance legislation. The second objective was to assess process for the patient care provided by STARS. A whether the Department of Health had an appropriate quality assurance process may have prevented or oversight process to ensure compliance by STARS detected earlier some of the noted patient-care with key elements of the service purchase agreement. concerns. During the course of our audit, however, we Mr. Chair, we also found that Health's licensing became aware of patient-care concerns. As a result, process appropriately assessed whether the licence we also looked at how the department responded to application requirements contained in the air these concerns. I would like to highlight several emergency medical response system regulation were findings. met. Because some key items were not submitted, Mr. Chairperson: Mr. Ricard, could I get you to Health issued provisional licences to STARS in 2012 speak up a little bit towards that end of the table and and 2013. we'll see– And, finally, we noted that certain aspects Mr. Ricard: Okay. Sorry. Should I–you don't want of the service purchase agreement were not me to start over, do you? adequately overseen by Health. We found that the submission of quarterly budget reconciliations by Mr. Chairperson: That's okay. You're good. STARS was not adequately monitored, resulting Mr. Ricard: In establishing the ambulance program, in an overpayment to STARS in 2012-13 of we found that Health did not conduct a public $2.4 million, and that performance indicators or tender. The decision to waive the competitive bid metrics were not developed for many of the requirement was not supported by any of the four operational requirements included in the service acceptable circumstances noted in government's purchase agreement, hampering Health's ability to procurement policies. In addition, Mr. Chair, this assess STARS performance. untendered contract was not disclosed in the public Thank you. access database, a requirement of The Financial Administration Act. We found that Health, when it Mr. Chairperson: Thank you. was planning for the helicopter ambulance program, Welcome to the honourable Ms. Selby, Minister did not conduct a detailed assessment to define all its of Health, and to the deputy minister, Ms. Herd. program delivery needs. The department cited a lack of internal expertise for the–for this task and timing Does the deputy minister wish to make an constraints that precluded the hiring of experts. As a opening statement? And could you introduce any result, during contract negotiations Health relied staff that you've brought with you today, please. on STARS as the main source to define program Ms. Karen Herd (Deputy Minister of Health): I delivery needs. Health did use various experts would like to introduce Ms. Jean Cox. She's the during contract negotiations, but, interestingly, not assistant deputy minister of regional policy and in aviation or helicopter emergency medical response programs and she'll be joining me at the table. services. Furthermore, Health could not demonstrate that it would be procuring this service for a * (14:10) reasonable cost, a critical step, given that the contract Thank you for the invitation here to speak with had not been tendered. The department obtained the Public Accounts Committee and answer your budget figures from STARS during the contract questions in relation to the helicopter emergency negotiation process and compared estimated costs to medical services program operated by the Shock those incurred by similar programs in other Trauma Air Rescue Society, more commonly known provinces and to the Manitoba Lifeflight program. as STARS. July 9, 2014 LEGISLATIVE ASSEMBLY OF MANITOBA 91

Emergency medical services are a crucial the eventual resumption of full services by STARS component of Manitoba's health-care system. Over in Manitoba. The Clinical Oversight Panel has the years, this system has dramatically changed from worked with physicians and staff at the leadership one primarily provided by volunteers to today's EMS levels of Manitoba Health, Healthy Living and system, which is a professional system that integrates Seniors, with STARS and with the Winnipeg ground and air operations across the province. What Regional Health Authority to address the issues has not changed over this time is the need for an outlined in the flight path report by Dr. Wheeler. emergency medical services system that provides The office of the Auditor General report titled patients with safe care. Helicopter ambulance program concentrated on Over the last year, Manitoba Health, Healthy the administration and management of the STARS Living and Seniors has worked with health-care program. The office of the Auditor General report experts to improve care in this area. When had five recommendations relating to quality clinical-care issues came to light through our medical assurance of the STARS service, a performance directors that act as the physician oversight of the framework for the contract, the tracking of times emergency medical services system, the department associated with primary-scene response versus contracted Dr. Stephen Wheeler from British interfacility missions, operational policy and Columbia to investigate the issues. Dr. Wheeler is an improvement of internal tracking of contract internationally recognized expert in helicopter EMS requirements, specifically insurance certificates. Of services with over 20 years of experience in the the five recommendations outlined in the OAG industry. As well, he acts as the medical director for report, three of the recommendations are completed the British Columbia air ambulance system. and enacted, those being tracking of times associated Dr. Wheeler was asked to review cases of concern with primary-scene response versus interfacility and reported critical incidents to identify common missions, operational policy and improvement root causes of failure and to develop recommen- of internal tracking of contract requirements, dations about how we could strengthen helicopter specifically insurance certificates. Two of the office emergency medical services in Manitoba. of the Auditor General recommendations have work currently under way and are projected to be complete At approximately the same time, the office of by the end of the 2014 calendar year, those being the Auditor General of Manitoba was concluding quality assurance of the STARS service and a its review into the STARS program. Their report performance framework for the contract. concentrated primarily on administrative and management issues associated with the STARS The progress that has been made in program. Both of these reviews have been extremely implementing the recommendations of both the useful to the department in strengthening patient office of the Auditor General report and the safety as well as the administration and management Dr. Stephen Wheeler report is considerable, but there aspects of this program. The department has is still work to do. accepted the findings outlined in both the office of Thank you for allowing me to have these the Auditor General and in Dr. Stephen Wheeler's opening remarks. reports. As well, the department has actively worked to implement the recommendations of these reports. Mr. Chairperson: Thank you, Ms. Herd. Manitoba Health, Healthy Living and Seniors' Now, prior to entering into questions and first and foremost priority is patient safety, thus starting here, I'd like to inform those that are new to recommendations affecting patient safety have been this committee of the process that is undertaken with implemented as a priority. Recommendations from regards to outstanding questions. At the end of every Dr. Stephen Wheeler's report, titled flight path, have meeting, the research officer reviews the Hansard been actioned through the Clinical Oversight Panel, for any outstanding questions that the witness which was announced by the Minister of Health (Ms. commits to provide an answer and will draft a Selby) on March 7th, 2014. The Clinical Oversight questions-pending response document to send to the Panel, chaired by Dr. Brian Postl, has the mandate to deputy minister. Upon receipt of the answers to those provide patient-focused guidance and oversight for questions, the research officer then forwards the helicopter emergency medical service. This oversight responses to every PAC member and to every other includes training and accreditation for personnel, member recorded as having attended that meeting. quality assurance for clinical operations and guiding At the next PAC meeting the Chair tables the 92 LEGISLATIVE ASSEMBLY OF MANITOBA July 9, 2014 responses for the record. So we will document what we're seeing in this audit, and I wonder if the responses that will be outstanding should you have deputy could indicate why the government has any of those. refused to make that feasibility study public. Now, before we get into questions, I would * (14:20) like to remind members that questions of an Ms. Herd: The 2009 feasibility study includes administrative nature are placed to the deputy confidential information and advice to Cabinet. This minister and that policy questions will not be is the reason why it was not released publicly, but, in entertained and are better left for another forum. the interests of providing full disclosure to the office However, if there is a question that borders on policy of the Auditor General, we did provide that and the minister would like to answer that question feasibility study to the Auditor General as they were or the deputy minister wants to defer it to the conducting their review. minister to respond to, that is something that we would consider. Mrs. Driedger: Certainly, there seemed to be a number of–fairly significant analysis made within The floor is now open for questions. that feasibility study that could certainly have Mrs. Driedger: My first question's to the acting ramifications on the decisions–or lack of decisions Auditor General. In his opening comments today he the government was involved in as they went has specifically made reference to the two previous through this untendered contract. Would there be, in untendered contracts of STARS in the previous flood order to ensure that there is absolute transparency– years and he has emphasized that those two contracts because this is one particular area, this whole that were in place previous were both untendered. helicopter ambulance program, where there has been sorely lacking transparency–would there be any wish I just want to ask him what he sees as their–as by the government now or desire by the government the tie-in with this current audit and the relevance to now to clear things up more and actually consider it. tabling that study? Mr. Ricard: Certainly. The–those two contracts Ms. Herd: The department did provide that were raised only because–okay, those two contracts information fully to the office of the Auditor General were raised because we wanted to make it clear that as we would support them in doing their audit. the relationship with STARS did not start with the However, we have not chosen to make the study contract that was signed in 2012. It really predated, public to ensure that confidential information and and that it might have had some impact on the advice to Cabinet remain such. negotiations and the contract leading–in 2012. That's–we didn't do any audit procedures on those Mrs. Driedger: Would there be an opportunity in two contracts to determine whether is–it was that feasibility study to, for instance, if there was any appropriate that they weren't tendered, for example, sensitive information, to just black it out, and if the although we note that they were issued during an government was concerned about any sensitivities, emergency situation which is one of the acceptable just have that part removed, redacted and then table circumstances for waiving the competitive bid the rest of that feasibility study? That actually does requirement. have a lot of bearing on the decisions the government made to enter into a contract with STARS. Mrs. Driedger: I appreciate that and certainly may be coming back to this; we're going through Ms. Herd: At this time, the department has chosen questions and finding the relevance in that particular to ensure that the confidential information and advice area. to Cabinet is maintained confidentially. But my first question, then, to the deputy We did provide information to the OAG, which minister would be, and it's going to–I'm going to start they did include or make reference to in their review, pretty methodically and just start on page 161 of the but it would not be our normal practice to provide audit where there is some reference to a feasibility advice to Cabinet in a way that is being requested study that was conducted in 2009, and the auditor here. didn't include the results of that study in the–this audit, but certainly has made reference to some of Mrs. Driedger: Can the deputy minister indicate the findings. It would seem to me that that feasibility that–in that study, it said that 35 to 50 lives would be study has some bearing, some significant bearing on saved annually. Without us now having the ability to July 9, 2014 LEGISLATIVE ASSEMBLY OF MANITOBA 93 look at that study, can the deputy indicate how those not even in keeping with what is happening, for numbers were reached? instance, in usage of the STARS helicopter in Saskatchewan. Ms. Herd: The transport volumes in that initial feasibility study were indeed higher. These estimates Can the deputy indicate how these numbers were based on a review of EMS calls from the area could be so far apart in terms of what was that was to be served by a helicopter emergency determined earlier on and what has actually system. As we know, since STARS' inception in happened in number of transports? Like, this is a April 2011 to June 30th, 2014, there have been very serious, serious gap in numbers, and can she 168 primary-scene transports and 283 interfacility just explain, rationalize what happened and what's transports. going on? Based on data from the last three years, STARS Ms. Herd: We definitely are relying on the work of will conduct approximately 146 transports a year. the Clinical Oversight Panel to ensure that STARS is This data is in alignment with industry-based utilized as fully as it can be in its current form. projections that estimate a helicopter program will transport approximately one patient per We can say that we recognize there is a 1,000 residents in a service area that do not have significant variance from the work done in 2009 to access to tertiary care. the numbers that we have experienced in the first three years. I think I can safely say the department It is our intention, through the Clinical Oversight will learn from the audit and from the work of the Panel, that we will ensure that the maximum Clinical Oversight Panel to ensure that it adequately volumes that can be attained safely will occur, but projects or improves its estimating practices in we would really defer to the work of the Clinical future. I think that's really the benefit of having the Oversight Panel to ensure that it's provided safely. audit and learning from the audit. Mrs. Driedger: Can the deputy just go back and Mrs. Driedger: The untendered contract for STARS refer to the number of 146, and just repeat what she was set at $10 million a year, and that amount was had indicated at–with that number? determined based on 600 to 800 patient transports Ms. Herd: Based on data from the last three years, annually. If we are only doing 146 transports a year, STARS will conduct approximately 146 transports a are–is the government still in a situation where they year. So that's based on the three years of experience have to stick with that contract and pay out that we have had with STARS, and we recognize that $10 million a year plus all the other costs for–you it's initial start-up and, you know, could change in know, that in total amounted to $159 million? future. But, if we base it on those three years, it would be approximately 146 transports a year. Ms. Herd: Okay, I would like to say that there are going to be some aspects of an emergency response Mrs. Driedger: That is significantly less than I think system, be it helicopter, be it land, that we're what was anticipated at the beginning. Can the basically paying to have that infrastructure in place, deputy just remind us what the anticipated number of so the contract would cover some aspects of training, transports per year the contract was based on? some fixed costs related to having that service in Ms. Herd: I bring your attention to page 3 of place. So those costs will be incurred regardless of the Auditor General report, or the third page in, the volume of the service. that says that the feasibility report found that a There are some aspects of the STARS operations Winnipeg-based helicopter could operate within a which they provide in their annual budget under the radius of approximately 250 kilometres, extending service purchase agreement that are variable, and so care to about 350,000 people. It was estimated in that each year we do a settlement with STARS on their report that between 600 and 800 patient transports actual costs. So it isn't always a fixed, set amount of annually, potentially saving 35 to 50 lives annually. $10 million. However, I will say that there is a large * (14:30) proportion of that amount that is a fixed cost, and that's to have the service available for Manitobans Mrs. Driedger: There is a huge disparity between that would need to access it. what is happening right now with the number of transports annually versus what was anticipated at Mrs. Driedger: Can the deputy indicate what the the time of that feasibility study, and it is certainly value of those fixed costs would be annually or as a 94 LEGISLATIVE ASSEMBLY OF MANITOBA July 9, 2014 percentage of the $10 million or as an actual government entered into a contract, untendered number? contract, for $10 million, but, if we go back to–and, again, it's on page 163–that feasibility study had Ms. Herd: We can get that information for you. I looked at an estimated cost of $5 million annually, don't have it here with me, but we will definitely get and yet the government then went ahead and it for you. paid twice the amount, in fact–[interjection] Yes, Mrs. Driedger: Now, the transports a year, 146, is $10 million a year for the program, and then went only a quarter of the projected volume that was and signed a 10-year contract for $100 million. determined that might be possible when the So is the deputy, then, indicating that Manitoba feasibility study was done, and they're just so off taxpayers are now stuck because we had an from reality and what is happening. untendered contract, we had no transparency, we had Who–was it the department that actually came no public ability to look at the decision that the up with the 600 to 800 as they wrote the feasibility government was taking? study, or did that number come from someplace else? Are–is the deputy now indicating that taxpayers Ms. Herd: Again, I'd go back to the fact that the are on the hook for $159 million for 10 years and 2009 report was developed by the department; it was there is no recourse, even though–no recourse the department's information. We had certainly financially, even though we are only going to be accessed information from many sources, but, using that service for a quarter of the time that it was ultimately, it was the department's report and we anticipated that we would need it for? have to stand by that. Ms. Herd: I go back to the reasons why we selected We do, however, take the point here, and, STARS back when we needed them in the flood of as was pointed out in the office of the Auditor 2009 and the flood of 2011. We felt they were an General's report, that the department has to do some organization with a long history and a proven track improvement, some learning from the audit, and do a record, and, while we were investigating potential better job at how it predicts and projects volumes. helicopter-based air ambulance service providers as I think I would add that we'll continue to rely on part of undertaking that feasibility study, we did the work of the Clinical Oversight Panel to ensure encounter the flood in 2009. So we contracted with that they can bring the services back to full service as STARS to provide the specialized emergency soon as possible, and access the most from that medical services via helicopter. I think, during those service that we have paid to bring here to the two flood experiences, we were very satisfied with province. their services. We thought that they had done good work and we knew that they could–that we could Mrs. Driedger: Can the deputy indicate, then, were continue on with the service rather than developing those volume projections absolutely wrong? something that could potentially have a stoppage in * (14:40) service. Ms. Herd: I think that the department really has to So I think we ensured that the service was learn from this experience, from the auditor's work provided, and I think we are seeing the benefits even and from what we've learned from having STARS now of having them available in a flood situation. here for the past three years, that our work from that Mrs. Driedger: I guess, with all due respect to the 2009 feasibility study probably was not what it deputy minister, that answer was something that should have been and that we need to learn from this certainly we've been hearing from the minister, and, I experience and try to ensure our practices to assess mean, it's been obviously determined all along that and develop proposals are more rigorous. I think we it was very much a political decision by the have taken steps to improve our analytical capability government to get into this contract without and our performance monitoring, but, as the Auditor tendering it and the auditor did not buy the General has pointed out, there's much more we can government–or accept the government's reasons for do, and we commit to continue to trying to do our doing so. In fact, the auditor slammed the best to improve our practices there. government for not tendering the contract and said Mrs. Driedger: Which is all well and good, but what there was no excuse for that, that the time frames we have found now, based on those projections, the were certainly there that could've allowed a proper July 9, 2014 LEGISLATIVE ASSEMBLY OF MANITOBA 95 tender. The fact that it was untendered twice before, Alberta that had a fleet of helicopters, so, for you know, also rears its head a little bit in here. example, if there were mechanical issues or a service that was needed, we could access the fleet within the But to go back to the actual question, you know– broader Canadian context. We knew they had a very and I would point out that even with the deputy's good reputation, a very long track record, and we answers, the auditor did point out that the value for recognized, as I said earlier, that the volumes are not money was weak in how the government went about what we expected or projected. So we have requested this. But now it's beyond weak. This is–I mean, these the Clinical Oversight Panel to do all it can to ensure numbers now that are coming forward, that the that their activity returns to full service and we service is only going to be needed for 146 transports continue to support and monitor the work of the a year for $10 million, and we are not–we don't even Clinical Oversight Panel to ensure that they can have an ability to adjust what we're paying. So resume to full service and continue to be part of that this has become a very, very costly service to modern EMS system that we have in place. But I Manitobans. would confirm that, yes, it is a 10-year commitment, And I would ask the deputy if there is no ability, it is a 10-year contract. now that you've got accurate numbers, to actually Mr. Chairperson: Ms. Herd, can STARS decline a adjust the amount of that contract? mission, and under what circumstances could they Ms. Herd: As I said earlier, we were very satisfied decline a mission, and has that occurred? with their performance in the 2009 flood, the Ms. Herd: STARS is dispatched, like all EMS 2011 flood. We believe this organization had a very activity within the province outside of Winnipeg, good track record and we've seen them be available through the Medical Transportation Co-ordination now in the flood that we're currently in in the Centre. So, if STARS had some sort of issue, province. perhaps like a service mechanical issue, they would I think I can say, though, that we go back and declare to the Medical Transportation Co-ordination take very seriously the learnings from this audit that Centre that they are out of service and not available the Auditor General has provided to us, and we will– for dispatch. It would not be the norm that they we have already begun to improve our analytical would be dispatched and then make a call into the processes and our processes of rigour to ensure that MTCC that they could not take the call. We aren't when proposals come forward they are reviewed as aware of such a circumstance, but my staff are best as can be within the department. So I think there looking into whether that has happened. I suppose it's is a learning for the department from this, and we do possible if there was some issue with weather or value the work that the Auditor General has done to some staff member on the flight, so I don't want to help us learn from this experience. say it's never happened, but normally their protocol would be to take themselves out of service so that Mrs. Driedger: As my colleague just pointed out, MTCC would not access them for dispatch at the expensive lesson, being satisfied with service during outset. a flood, and I will ask some questions specifically about that, but that really doesn't, I guess, answer my Mr. Chairperson: All right, and then following up question. from that, Ms. Herd, other than the times that they were grounded, have they withdrawn themselves And the question is, are we committed, then, to from service for mechanical reasons or any other this contract? There is no out for government. You reason? know, based on this dramatic new information, is there no out for the government with an ability, then, Ms. Herd: STARS has, in the past, removed to tender again for decreased usage? themselves, taken themselves out of service due to, in the past, weather-related issues, sometimes * (14:50) related to a mechanical service issue or potentially Ms. Herd: We have made a 10-year commitment to even a training issue. These are not normally STARS; the contract is for 10 years. We believed lengthy out-of-service provisions and they would– that it was important to have a helicopter as part of a if something was a lengthy service-related or modern EMS system. We also felt it was of benefit mechanical issue, there would be discussion related to the Province to have the ability to access an to accessing other helicopters within the organization with operations in Saskatchewan and STARS fleet. 96 LEGISLATIVE ASSEMBLY OF MANITOBA July 9, 2014

Mrs. Driedger: A question to the acting Auditor today's day and age, helicopter ambulance support is General: Certainly, when the government signed this very valuable and all provinces have it. So I don't untendered contract for 10 years, there was a hue and dispute the need for that. cry from the aviation industry, not only for the You know, I think where our problems have untendered contract but the length of that contract. always lain–laid is with the fact that the government Do you find that–or did the auditor's office find it chose to go forward with this in an untendered unusual to have such an expensive contract or any way. Had they tendered the contract, STARS, you contract signed for that length of time? know, could very well have won that contract, you Mr. Ricard: I don't really think I can comment know, the way contracts and the criteria are within specifically on the question that you're asking in contracts. So, you know, certainly if STARS met all terms of the unusualness of the time frame. But I the criteria, none of this would be before us. But it would draw your attention to, in our report, on was the fact that the government went down the page 172, section 122, where we do talk about the road–and now it looks like they went down the road SPA includes termination provisions. with erroneous information, in fact, that we're only going to have 146 transports a year, which is far So, yes, it's a 10-year commitment, but the–part below what was anticipated, I think, actually, is quite of what Health did when it negotiated the contract explosive information. The fact that the government was ensure that there was termination potential. So is not interested in, you know, evaluating the cost on [inaudible] Health can suspend service and either something like this is somewhat alarming. party can leave the SPA with one-year notice for any reason. * (15:00) Mrs. Driedger: Thank you. That was going to be my The deputy has also indicated that they want to next question to the acting Auditor General because I get the air ambulance, the helicopter air ambulance, was aware that that was put into the contract. So, in back up and fully functioning. Can the deputy effect, then, back to the acting Auditor General, what indicate if that has already happened? the deputy minister is indicating right now, then, There's certainly been some reports in the would not be totally accurate because there is an media that the STARS helicopter was sent for an ability, if the government so chose, to actually revisit interfacility transfer on Friday. Can the deputy then the contract, and that's already put in writing within indicate, is that accurate? Is STARS fully functional the contract. Is that accurate? now with the information in the media that there was Mr. Ricard: Yes, the contract can–the SPA includes an interfacility transfer on Friday? a clause for termination. Mr. Chairperson: Mrs. Driedger, that's a little Mrs. Driedger: So then back to the deputy minister outside of the parameter of this report, but I think on that, as that is in the contract, can the deputy there's interest in the committee if the deputy is indicate why her responses have not included that in interested in answering that. her answer? Ms. Herd: The STARS has been resumed to Ms. Herd: Like probably any standard contract, interfacility transport which was another key aspect there is termination clauses in a contract. But I of their services. As you may know, in March they guess what I was trying to impart is that it is not were allowed to resume scene calls, and, in response our intent to terminate the agreement. We entered to the issues that we were seeing with the state of into a 10-year agreement with STARS because we emergency and based on the information that had felt they were a key component of a modern been provided by Dr. Postl, the next step was to emergency management system, and we entered into include interfacility transports. that 10-year agreement because we believed that that There is, however, though, still some aspects of was what we wanted to do and have in the province. service that need to be worked through at the Clinical So our–I guess I'm speaking to intent; our intent is Oversight Panel, and that would relate to dealing not to terminate the agreement. with the very challenging cases of pediatric care. Mrs. Driedger: Appreciate the comments from the So that is still an area that–pediatric interfacility deputy, and I don't dispute the ability of STARS transfers are not part of what STARS could do at the to do the job. I don't dispute that we need a current time. They could respond to a pediatric scene very modern air ambulance service, and certainly in call if that was needed. But they, at this point, are not July 9, 2014 LEGISLATIVE ASSEMBLY OF MANITOBA 97 in a position to be allowed to deal with a pediatric by the oversight panel. Is that something that could interfacility transport right now. So that is still work be tabled? that is being undertaken at the Clinical Oversight Ms. Herd: Yes, my staff advised me that we can– Panel. that the protocol is actually MTCC's protocol, but we Mrs. Driedger: How did the Clinical Oversight can certainly get that and provide that. We don't have Panel relay that information to government? it here today, but, yes, we can provide that, the dispatch protocol. Ms. Herd: As you know, the Clinical Oversight Panel has medical experts from the department, from Mrs. Driedger: And can the deputy explain what STARS and, of course, Dr. Postl as chair. So those has changed to improve the dispatch protocol that experts have been discussing matters, clinical and would now allow interfacility transport of adult patient-care related, at the Clinical Oversight Panel. patients to resume? We do have department representation that * (15:10) attends the Clinical Oversight Panel, and I will also Ms. Herd: Okay, I would want to stress the fact that say that Dr. Postl has been keeping me as deputy it's really the decisions made at the Clinical apprised and he has also been briefing the minister Oversight Panel that allow us to move in this on the progress made at the Clinical Oversight Panel. direction. It's the medical experts, and there are many I would also add that on the Clinical Oversight Panel around that table from the department, from STARS, is representation related to MTCC, so from the Dr. Postl himself, MTCC, that made this decision. dispatch side as well. Initially, the resumption for scene calls, which is for So it's the work that has been done by the emergency dispatch, was to ensure that we have an medical experts at the Clinical Oversight Panel that emergency medical service that is there should we have made a determination that it's appropriate need to get to a remote location. But then, as we for them to return to that service of interfacility wanted to expand the services that they could transports, not including pediatrics. But they've provide, further work was done at the Clinical certainly been keeping department officials, the Oversight Panel to look at things related to training, deputy and the minister apprised through briefings. accreditation and matters like that. It is our understanding that they are working on So there are the things that the Clinical this further and they continue to work on it, but that's Oversight Panel has been focused on, and it was the current situation of how they've been keeping us through their deliberations and their discussions that informed. they agreed to a broader dispatch criteria than we originally had at March. Mrs. Driedger: So would Dr. Postl just have picked up the phone and made a phone call to the deputy or Mrs. Driedger: Did the flood have any impact on to the minister saying, go ahead and start interfacility speeding this up? The deputy made a reference to the transfers on adults, that's okay? flood coming and STARS would be an important part of that. All along the messages coming out of Ms. Herd: Okay, I would like to say that the government has been about the importance of patient members of the Clinical Oversight Panel that are– safety. that represent the department did sign off on the dispatch protocol related to this additional aspect of But now I do have to ask the question: Has STARS service. There was recognition that with the there been some speed-up of some of this or a flood coming that STARS could be an important part determination made by the oversight panel that of that plan. There had been significant work done things seem to be good enough right now to launch and achieved at the Clinical Oversight Panel. I would during the flood? say, yes, certainly, Dr. Postl would phone, actually, But, certainly, we're not seeing any report after every Clinical Oversight Panel to report to me, from them. We're not seeing them put forward but he did have a formal briefing with the minister written recommendations. They've been given, as an in–very shortly before we moved them into service oversight panel, a significant challenge to pull things resumption related to interfacility transports. together, and yet, out of the blue, on a Friday, no Mrs. Driedger: Now, the deputy indicated that there government announcement, and the government's is a dispatch protocol that has been developed now never missed an opportunity for a–you know, 98 LEGISLATIVE ASSEMBLY OF MANITOBA July 9, 2014 a photo op here when it's come to STARS. Like, all * (15:20) of a sudden, this is happening very quickly. Mr. Chairperson: I'll leave it up to the deputy for So I'm just a bit troubled that with the oversight that one, whether she wishes to answer it. I think it panel that was supposed to be doing, you know, a kind of flowed from the flood discussion. I can–if the significant amount of work, as suggested by deputy has difficulty answering it, I can tell you what the auditor, that–has any of that been shortcut– I know of it from Minister Ashton, but it's not the 'shortcutted,' if that's a word, because of the flood? same service as STARS, is what I've been told. It is there in a–if someone is, shall we say, marooned on Ms. Herd: As I said in my opening comments, the their farm and can't get out, that's the intent of the department's first and foremost priority is patient helicopter, but not to replace STARS, was my safety, and so I will say that the Clinical Oversight understanding from the Premier (Mr. Selinger) and Panel has met in March, April, May and June, and it Minister Ashton. was through that work and the additional work done by Dr. Postl, as he began to formulate how STARS Mr. Struthers: I think you just made my point. As could return to full service with the aid of those Chair of PAC, you're just speculating and answering other medical experts, that he requested a briefing on behalf of the government on an issue that I think June 23rd with Minister Selby. is totally separate from what we're dealing with here today. I'm sure the–I'm sure the Auditor General At that briefing, he talked about the progress that could indicate if this is any part of the report that had been made. He said we were very close to being we're dealing with today. I don't want to put him in in a position to resume service, and then when we that spot, but I do think this is outside of the scope of knew that we were moving into a state of emergency, what we're dealing with here today. I don't mind the discussion occurred with him and the medical listening to the question that's going on, but I do experts on the Clinical Oversight Panel to see want it to be connected to what the purpose of this whether they felt that sufficient work had been done meeting is. in those meetings of the Clinical Oversight Panel in March, April, May and June. And they did come to a Mrs. Driedger: I might be able to connect it with the decision to allow interfacility transfers to begin, next question because we know that the STARS granted not children, not pediatrics, because they felt helicopter was used in '09 for the flood and 2011 for that it was important that that service be available the flood. My next question would be, the during the state of emergency. government did track how many times STARS was used in both those situations and indicated that it was Mrs. Driedger: I noticed, also, in the media a valuable service. What has never been provided is last week, there was mention of a Conservation a breakdown of what those transfers were about. helicopter being put into Brandon for health Were any of those transfers in '09 and '11 for purposes. What's the difference between, then, the marooned people, for instance, versus for actual government making that announcement that they're health calls? putting a Conservation helicopter there for these purposes and now–and, I guess, how does it compare Mr. Chairperson: Well, I'll leave it up to the deputy to what the service is, then, that STARS is being whether she wishes to address this question and allowed to do now and be involved in? hopefully we can move on to–back to the report. An Honourable Member: Point of order. * * * Point of Order Ms. Herd: Okay. I think that what I'd like to say about the STARS helicopter is that the advice we Mr. Chairperson: Point of order, Mr.–Honourable were getting is that it could be–its base, if you will, Mr. Struthers? could be Portage la Prairie so that it could service Hon. Stan Struthers (Minister of Municipal several flooded areas or several areas of the province Government): Yes, I'm just looking for your affected by high water, whereas moving it to guidance on this. Is–I'm not sure what the connection Brandon, I was informed–or my department had to that question that was just asked and the report informed me that moving it to Brandon solely would that we're dealing with through our committee here not allow it to access other areas of the province today. Maybe I'll ask you for your guidance as to where it might be needed, like the Whiteshell with whether that's within the scope or not. high water or Interlake. This way, they could provide July 9, 2014 LEGISLATIVE ASSEMBLY OF MANITOBA 99 service to both Whiteshell, Interlake and the western program. I wonder if the deputy minister could just part of the province, and I think, because there comment on the auditor's conclusions, which was already the Conservation-related helicopter in basically are in disagreement with the government's Brandon, that provided an extra level of comfort. own comments about why they did not tender the Granted, the helicopter in Brandon was not equipped contract. like STARS, but I think we tried to model the same Ms. Herd: It was our view that it was most practice we had used with the previous floods, which important to ensure there was uninterrupted service was trying to keep it in an area that–where it would to Manitobans, and, when the flood hit, we ensured be accessible for more cases, if you will, than that STARS was here. So we definitely wanted moving it further out west. to have STARS remain in the province in an Mr. Chairperson: Mrs. Driedger. operational way, and we realized that it wasn't We'll try to get back towards the report then. sustainable for them to continue in that way that they were during the flood where the Alberta crews were Mrs. Driedger: Yes, and I appreciate the infor- cycling through. So we made the decision–or mation from the deputy. government made the decision to continue with The oversight panel that was recommended, and STARS. the minister–or the deputy minister did indicate how I would say, though, the department–and it's often they met, are there written minutes of their even noted in the office of the Auditor General's meetings, and is there going to be a final report or report–the department accepts the findings of the any interim reports that are going to be public? Auditor General and we have committed to act Ms. Herd: There are not minutes taken at the immediately to implement them. Clinical Oversight Panel; however, we have ensured So I don't in any way mean to imply that we that there is department representation and Winnipeg disagree with the auditor's findings. We accept what regional health representation at the panel so that the they've identified and we commit to ensure that such operational side, not just medical leadership, can a thing will not reoccur. continue to ensure that STARS can get fully up and running. * (15:30) So there are not minutes made, but there will be Mrs. Driedger: Can the deputy tell us whether or a report. Dr. Postl has talked about the report, and, not, now, with her statement that she accepts the yes, we do intend to make it public. auditor's comments, what is happening now within Mrs. Driedger: Can the deputy indicate when that the department related to public tendering? report is anticipated to be completed? Ms. Herd: The department's position is that Ms. Herd: Dr. Postl has indicated to us that he will all matters of tendering should and will follow have it to us very shortly. government policies. We've been very clear about Mrs. Driedger: And will it be made public at that that. I know we also will ensure that we–ensure we time? monitor compliance of tendering and following government policies, including any changes that may Ms. Herd: Yes, we intend to make it public. occur to government policy. But the department's Mrs. Driedger: Related to the issue of no public position, and my position that I've strongly stated to tender and value-for-money analysis was weak, staff in the department, is that they must comply with which were findings by the auditor–in fact, there are government policies, and we support the findings of some comments made in the auditor's report quite the Auditor General and we intend to comply with extensively about all of this–and I would ask the them and what they're recommending. deputy to indicate, you know, based on the auditor Mrs. Driedger: Can the deputy, then, explain that making these conclusions and indicating that there when we look at governing procurement principles– was sufficient time available to bring in aviation and there are seven of them–every one of them were experts, the auditor basically disagreed with the broken when this untendered contract happened. Is government which said they didn't have the time. the deputy now indicating that on a go-forward basis, The auditor indicated there was enough time that all of these procurement principles will now be regarding tendering and procurement of a helicopter properly followed? 100 LEGISLATIVE ASSEMBLY OF MANITOBA July 9, 2014

Ms. Herd: As was stated, the audit is very clear on Mr. Ricard: I would–to answer that I would refer what occurred and what the department did not do. I the member to–or chapter 10 where we do talk think we've tried to provide, within our response to about the waiving of competitive bids. So we did the audit and in other venues, the rationale and do a government-wide audit on the waiving of reason for why that did not occur, including the fact competitive bids and found a number of problems that it was felt extremely important to ensure the across several departments and SOAs. STARS service remained available in Manitoba. However, I stand by my comment earlier that the And so, in terms of, you know, the application of department has learned from this experience and policy, the strict adherence to policy, there are many from the findings of the office of the Auditor factors that need to come into play to make sure that General, and our position is that all matters of everyone within the department is acting in a manner tendering should and will follow government that's expected. Things will go off the rails; we policies on a go-forward. The past is what it is and I understand and acknowledge that. That's why we can't change that, but we will ensure that matters of have processes like the auditor going in and checking tendering should and will follow government to see that things are being complied with. policies on a go-forward. So, you know, what I heard the deputy say was Mrs. Driedger: And can the deputy just indicate, acknowledge that there was a problem and that they too, that the reporting aspects of that will also be are looking at ways to ensure government-wide– followed as expected through all the rules in within Health itself–that the policy–that they have legislation? better processes for ensuring the approved policies Ms. Herd: We do recognize that the office of the are complied with. So it seemed like a reasonable Auditor General had identified challenges with the comment. department reporting. So, since then, in response to Mrs. Driedger: Certainly, and, in looking at the audit, I would like to advise that controls chapter 10 as well, in the audit report it certainly, I regarding contracts have been reviewed based on the think, was also a scathing indictment of where STARS audit and the department has implemented government was dropping the ball in a number of the following changes to its processes for untendered areas. And this, as we can see, is probably just one contracts: There's a use of a standard reporting area of how the government is getting a little bit document, including implementing a schedule for sloppy in terms of how they're doing business, and reporting to ensure reports are completed every hopefully some of this is a wake-up call, certainly, two weeks, including nil reports if no untendered for lots of areas of government to tighten up controls contracts are entered into; we've implemented a and follow the rules a little bit better. review process where the senior finance officer ensures the general manual of administration policies Mr. Chair, can I ask the deputy minister what are adhered to; and we've implemented further criteria the department uses to determine when a review and sign-off processes which now include the value-for-money needs assessment is required? chief financial officer and assistant deputy minister, in addition to the deputy minister, prior to the Ms. Herd: The criteria would be specific for contracts being posted in the Legislative Library. each contract based on their deliverables, but the general principles that we would look at in terms Mrs. Driedger: I'd like to ask the acting Auditor of a value-for-money assessment are the following: General if he's satisfied with the direction the meeting of targeted deliverables, audited financial government is taking, knowing that these–you know, statements or any audit opinions that report items there is a procurement administrative manual, there of concern, a recurring deficit, a recurring surplus, are rules for waiving of competitive bids, there are variance analysis of expenditures to budget, concerns governing procurement principles. Like, these things brought forward from other sources, and any were all in place long before, and the department environmental scan identifying gaps or differences chose to basically break or ignore. from activities in other jurisdictions or things Are you satisfied with what you're hearing from that may flag extreme differences here. So those the deputy right now that–you know, it's like a mea are the criteria that we have talked about in culpa. We're learning, we're going forward; is that terms of determining when a value-for-money good enough? needs assessment is required. July 9, 2014 LEGISLATIVE ASSEMBLY OF MANITOBA 101

Mr. Wayne Ewasko (Lac du Bonnet): To the So we know that there is a possibility, or the deputy minister, I'm just reading a passage here in auditor has pointed out to us their view that had we the Auditor General's report on page 165. It says gone into the marketplace there possibly could have that: "The Minister went on to say, about signing of been other suppliers. However, we were going with the MOU with STARS in June 2011, that 'there had the ones that had a proven track record in providing been no other organizations expressing any interest service of this scope and magnitude. before this date.'" Mr. Ewasko: Now, looking at the policy document How would they–how would the minister with the seven governing procurement principles, possibly know that, if there was no tender put out or the seven–and in order–say the principles are any information put out, that they were looking for open, and then the Auditor General found that the any type of service provider with this contract? government failed to be open on the government procurement principle. Fair: Suppliers were not * (15:40) treated fairly as there was no opportunity for potential suppliers to bid. That's what the auditor Ms. Herd: The minister received that information brought forward. Transparent: The Auditor General from the department. My staff tell me that Manitoba said the procurement process was not transparent as Health had preliminary conversations with Ornge there was no public tender. Possible vendors did not and Helijet, other providers of helicopter EMS have access to information or knowledge of Health's services, but neither was able to immediately provide procurement intent. Number 4 is ethical: The Auditor service for rural patients in Manitoba. So the General found that we–that they had found department had provided that information to the no specific ethical breaches, but failing to tender minister, which is presumably the way in which she did not help necessitate confidence, trust and good provided it. faith with potential suppliers. Number 5 is qualified: Mr. Ewasko: Thank you, deputy, Ms. Herd, for that The Auditor General found that certain senior answer. individuals at Health were not knowledgeable of some procurement policies, guidelines and best Now, then, if you–bearing that answer, if you practices. There was a general lack of awareness and turn to page 168, it says that there are four key understanding of exemptions–exceptions to tender exemptions–exceptions when waiving competitive requirements. Integrity was not maintained in the bids. And one is–you mentioned about immediate procurement process. Number 6, responsive and need, and for Ornge and Helijet–but it states here supportive: By not conducting a public tender also that the SPA–the government at the time there was no contribution to potential supplier announced in 2010 that it wanted a permanent development and growth or to fostering respectful HEMS system in Manitoba. However, the SPA was and effective relationships with suppliers. And, not signed until February 22nd, 2012. No. 7, value for money: Without the benefit of a tendering process, Health could not demonstrate that So to me that's not showing that there was an they are achieving a value for money, balancing immediate need. It showed that there was time for price with economy, efficiency and effectiveness of the contracts or the tendering to–tendering process to the goods and services acquired. be put out there. And I do know, in fact, that we do Now, I know the deputy has mentioned on more have air ambulance or helicopter providers within the than one occasion that they thank the Auditor province that I'm sure, given that time frame, the two General for–or that she thanks the Auditor General years, that they would have been able to provide that for the information and that they're going to try service if they were given the chance. harder and work harder and put things into place so that they are going to be following government Ms. Herd: As I said, staff did identify those major policies. But I'm pretty sure–and I don't know, players, Ornge and Helijet, as not being able to maybe the deputy does know, when the government's provide that service to Manitobans, but we take procurement administration manual was published. the point as we've accepted the audit. There is further point made in the audit that there is no Ms. Herd: I would like to advise that the procure- documented evidence to conclude that only one ment manual, the general manual of administration supplier could meet operational technical and and many other aspects of government policy are performance requirements. available to all government employees that have 102 LEGISLATIVE ASSEMBLY OF MANITOBA July 9, 2014 access to the government Internet site. So, even if the Mr. Friesen: I had another question for the deputy policies get updated, they are fully available in their minister. The deputy minister indicated earlier that most current form on the Internet. the department has representation on this committee as well. Did the minister indicate–deputy minister I don't have the exact date that the government's indicate which of those members are representatives procurement manual was introduced, but I certainly of the Department of Health on that committee? am aware that the current manual, in its most current form, is available on the Internet for all government Ms. Herd: That would be Dr. Renate Singh and civil service employees to access and would be Dr. Tony Herd. As well, we have a presence at the available to anybody who wished to. committee. It's not in a voting way, but Ms. Jean Cox, who's sitting beside me here, attends the Mr. Ewasko: Thank you, Ms. Herd, for that Clinical Oversight Panel meetings as an observer. comment. I guess this is more so a comment as opposed to Mr. Friesen: I thank the deputy minister for that a question–I'm going to turn it over to my colleagues. response. But, that being said, the deputy minister just We understand that the Auditor General's office, reaffirms the fact that the steps to–for government you know, undertook this study, to a great degree, to follow procurement principles are–have been, because they were asking the question if Manitoba whether it's been online or accessible to civil Health had the appropriate oversight process to–with servants, government officials, absolutely all of the respect to STARS and the original service purchase above for quite some time. So I find it inexcusable to agreement. ignore those seven principles. And, even with that, they even give you a–give the government a–four I wonder if the deputy minister would provide an key exemptions, sort of get-out-of-jail-free card if opinion of why it is that the–that Health decided to you want to exempt bids, and the Auditor General proceed in the manner they originally did. Certainly basically says that the four points for waiving a there is a template out there where we have groups competitive bid were not satisfied as well. and agencies who deliver services to Manitoba So I truly do hope that the government, in their Health and then who are–who receive oversight; I next, you know, maybe year and a half tries a little think about DSM. And there is a formal qualitative–a bit harder on their tendering processes. quality-assurance process. It is arm length, it is funded by government, but it proceeds independent Mr. Cameron Friesen (Morden-Winkler): My of government to provide the highest quality of question for the deputy minister has to do with the standard in that sector. Clinical Oversight Panel. I don't believe that in the context of this committee this afternoon we have I wonder, in this case, why was it–who–why was actually heard listed a list of the individuals who it that the department chose to proceed with a model comprise that committee. I wonder if the deputy that was far more in-house, informal and ad hoc, and minister would indicate the names of the individuals who would have undertaken to make that decision? who are on the Clinical Oversight Panel and what Ms. Herd: The decision regarding STARS and their role is there. where the oversight would be sited at the time–again, Ms. Herd: I'm reading off the terms of reference of from what I understand, because STARS would the Clinical Oversight Panel. The membership is: serve many parts of the province, not just one lead physician, Dr. Brian Postl; Manitoba air ambu- regional health authority–there was a view that lance associate medical director, Dr. Renate Singh; similar to Lifeflight, which is also housed within the MTCC associate medical director representative, Dr. department, or Selkirk Mental Health Centre or Kobus Du Preez; STARS Winnipeg base associate Cadham Provincial Lab, that STARS would be medical director, Dr. Doug Martin; STARS senior overseen directly by the department–we'll say medical leadership, Dr. J.N. Armstrong; Manitoba entities that are within the department but still ground ambulance associate medical director, Dr. providing direct service, like Selkirk Mental Health Tony Herd; non-voting WRHA CEO and/or Centre. They operate under very appropriate designate is Arlene Wilgosh. circumstances. They're accredited by Accreditation Canada. In no means are their services lesser than * (15:50) what would be offered in a regional health authority. July 9, 2014 LEGISLATIVE ASSEMBLY OF MANITOBA 103

So that–it was that thinking that–similar to doing quality assurance. Quality assurance to Lifeflight, that STARS would be run under program reviews will be conducted based on the auspices of the department, and that was the reported concerns, requests to investigate, as well as decision made at that time. But, certainly, just as I randomly, and they will utilize dispatch records and said, as Selkirk Mental Health Centre or Cadham electronic medical and patient-care records. Findings Provincial Lab, that follows CAR accreditation–or from these reviews will be provided to medical CAP accreditation, which is the Association of professionals involved and will be used, if necessary, Pathologists. We certainly in no way feel that those to develop remedial actions, alter treatment practices areas provide an inferior level of service or anything and create and enhance educational programs. like that. It was really a decision made similar Over the 2014 fiscal year–'14-15 fiscal year– to those types of services that run through the the quality assurance program will be implemented department. within the office of medical direction. Mr. Friesen: So, Mr. Chair, obviously, now the Mr. Chairperson: Given that we are approaching recommendation of the Auditor General has been 4 o'clock and that was the agreed time to which we for the–you know, the department to provide a would sit, what is the will of the committee? more formal process of oversight. And I–the deputy minister has indicated today that they are in support Mrs. Driedger: Mr. Chair, there is still several of the findings of the office of the Auditor General. hours' worth of questions that will be forthcoming. I don't see us having any ability to get it all done I wonder if the deputy minister would just today, so I would recommend that we probably rise indicate succinctly for us here, so we understand, for today and come back at another date. what is the main change, then, from the initial way in which a quality assurance would have been Mr. Chairperson: Well, does the committee agree? maintained, to the new model that will be undertaken [Agreed] by the Clinical Oversight Panel. What, in the All right, prior to rising, it would be appreciated simplest forms, are the changes? What is the if members would leave behind any unused copies of additional oversight that the new panel will provide the report so it may be collected and reused at the and what difference will it make for the operation of next meeting. STARS safely in Manitoba? Thank you to the minister and her deputy Ms. Herd: In terms of the quality assurance minister and staff for appearing with us today, to the program, as part of the EMS review of 2013, the deputy Auditor General and staff, and, of course, to need for a quality assurance program across the our page, our clerks–we had two today–and research entire EMS system was identified. The department officer and the Hansard staff, who apparently I prioritized this recommendation for implementation, neglected to thank last time and they noticed. So and early in 2014, the office of medical direction was thank you to everyone. And, of course, to the PAC established. The office of medical direction's role members for being with us today. is to ensure consistency of medical training and practice across the EMS system in Manitoba. To So it being–the hour being 4 o'clock, what is the ensure this consistency, monitoring and evaluation of will of committee? the system's medical performance will be essential, and this is accomplished through a quality assurance Some Honourable Members: Committee rise. program. Mr. Chairperson: Committee rise. The quality assurance program will be led by an assistant medical director specifically tasked COMMITTEE ROSE AT: 4:00 p.m.

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